Unifying considerations and evidence of macrophage activation mosaicism through human CSF1R and M1/M2 genes.

Addressing the mononuclear phagocyte system (MPS) and macrophage M1/M2 activation is important in diagnosing hematological disorders and inflammatory pathologies and designing therapeutic tools. CSF1R is a reliable marker to identify all circulating MPS cells and tissue macrophages in humans using a single surface protein. CSF1R permits the quantification and isolation of monocyte and dendritic cell (DC) subsets in conjunction with CD14, CD16, and CD1c and is stable across the lifespan and sexes in the absence of overt pathology. Beyond cell detection, measuring M1/M2 activation in humans poses challenges due to response heterogeneity, transient signaling, and multiple regulation steps for transcripts and proteins. MPS cells respond in a conserved manner to M1/M2 pathways such as interleukin-4 (IL-4), steroids, interferon-γ (IFNγ), and lipopolysaccharide (LPS), for which we propose an ad hoc modular gene expression tool. Signature analysis highlights macrophage activation mosaicism in experimental samples, an emerging concept that points to mixed macrophage activation states in pathology.

Enabling successful change in a high-demand working environment: a case study in a health care organization.

PURPOSE: The anticipation of organizational change and the transition process often creates uncertainty for employees and can lead to stress and anxiety. It is therefore essential for all organizations, especially those that operate in high-demand working environments, to support the well-being of staff throughout the change process. DESIGN/METHODOLOGY/APPROACH: Research on how employees respond to the organizational change of relocating to a new work space is limited. To fill this gap in the research, we present a case study examining the well-being of clinical and health care employees before and after a disruptive change: relocation in workplace facilities. In addition, factors that enabled successful change in this high-stress, high-demand working environment were investigated. Interviews were conducted with 20 participants before the relocation and 11 participants after relocation. Following an inductive approach, data were analyzed using thematic analysis to identify key themes. FINDINGS: Our findings suggest that a supportive team, inclusive leadership and a psychologically safe environment, may buffer negative employee well-being outcomes during disruptive organizational change. ORIGINALITY/VALUE: This research contributes to the literature on successful organizational change in health care by highlighting the resources which support well-being throughout the change process and enabling the successful transition to a new facility.

Comparison of Corticosterone Concentrations in Dermal Secretions and Urine in Free-Ranging Marine Toads (Rhinella marina) in Human Care.

Corticosterone concentrations have been measured in amphibians by collecting blood or urine samples. However, blood sampling is invasive, and urine can be difficult to collect. A novel method of swabbing the skin of an amphibian has been utilized in numerous species but has not been verified in marine toads (Rhinella marina). This pilot study tested dermal swabs as a noninvasive method for collecting and measuring dermal corticosterone secretions. Swabs were used to collect dermal secretion samples from sixty-six free-ranging marine toads collected on Zoo Miami grounds. The subsequent day the toads were shipped to the North Carolina Zoo where dermal samples were collected again. Additional dermal and urine samples were collected on days 9, 15, 32, and 62 under human care to measure corticosterone concentrations. There was no significant correlation (P ≥ 0.05) noted between corticosterone concentrations reported in dermal swabs and those in urine samples at all four of the euthanasia time points or between the corticosterone concentrations reported in either urine or dermal swabs and the weight of the toads. Dermal swab concentrations (ng/mL) were significantly higher (P ≤ 0.05) on the day of capture (0.64 ± 0.03) and the day of arrival (0.67 ± 0.03) than on day 15 (0.47 ± 0.03). The urine corticosterone concentrations decreased while the toads were in human care with a significant decrease (P ≤ 0.05) between days 9 (0.45 ± 0.07) and 32 (0.21 ± 0.06). This study demonstrated that dermal swabs can be used to collect marine toad corticosterone concentration samples.

Understanding the patient and family experience of nutrition and dietetic support during childhood cancer treatment.

PURPOSE: This study aimed to understand the experience of families caring for a child with cancer in New Zealand (NZ) who received nutrition and dietetic support during cancer treatment and their preferences for the delivery, format, and timing of nutrition information. METHODS: Childhood cancer patients and their families (N = 21) participated in a mixed-methods study at a specialist paediatric oncology centre in Auckland, NZ. Before the semi-structured interview, participants completed a questionnaire capturing demographic, disease, and treatment characteristics of their child, their nutrition concerns, and their information needs. Quantitative data were described, and qualitative thematic analysis of the semi-structured interviews was performed using NVivo data analysis software. RESULTS: Eighty-six percent of participants indicated they had concerns about their child's nutrition during treatment. The most common concerns were anorexia, vomiting, and weight loss. While many were happy with the quality of the nutrition support received, one-third of the patients wanted more support. Four key themes emerged from the interviews: (1) patients experience significant and distressing nutrition challenges; (2) patients and families have mixed perceptions of EN; (3) there are gaps in the current nutrition support system for inpatients; and (4) a desire for more accessible nutrition support. CONCLUSION: Childhood cancer patients and families experience significant and distressing nutrition challenges during treatment. Standardising information given to patients and their families may optimise nutrition support for paediatric oncology patients and reduce the discordance between families and health professionals. Future implementation of a nutrition decision aid in this population is warranted.

Critical care pharmacy workforce: a 2020 re-evaluation of the UK deployment and characteristics.

INTRODUCTION: Critical care pharmacists improve the quality and efficiency of medication therapy whilst reducing treatment costs where they are available. UK critical care pharmacist deployment was described in 2015, highlighting a deficit in numbers, experience level, and critical care access to pharmacy services over the 7-day week. Since then, national workforce standards have been emphasised, quality indicators published, and service commissioning documents produced, reinforced by care quality assessments. Whether these initiatives have resulted in further development of the UK critical care pharmacy workforce is unknown. This evaluation provides a 2020 status update. METHODS: The 2015 electronic data entry tool was updated and circulated for completion by UK critical care pharmacists. The tool captured workforce data disposition as it was just prior to the COVID-19 pandemic, at critical care unit level. MAIN FINDINGS: Data were received for 334 critical care units from 203 organisations (96% of UK critical care units). Overall, 98.2% of UK critical care units had specific clinical pharmacist time dedicated to the unit. The median weekday pharmacist input to each level 3 equivalent bed was 0.066 (0.043-0.088) whole time equivalents, a significant increase from the median position in 2015 (+ 0.021, p < 0.0001). Despite this progress, pharmacist availability remains below national minimum standards (0.1/level 3 equivalent bed). Most units (71.9%) had access to prescribing pharmacists. Geographical variation in pharmacist staffing levels were evident, and weekend services remain extremely limited. CONCLUSIONS: Availability of clinical pharmacists in UK adult critical care units is improving. However, national standards are not routinely met despite widely publicised quality indicators, commissioning specifications, and assessments. Additional measures are needed to address persistent deficits and realise gains in organisational and patient-level outcomes. These measures must include promotion of cross-professional collaborative working, adjusted funding models, and a nationally recognised training pathway for critical care pharmacists.

Uterine Tube Resection by Vaginotomy as an Alternative to Ovariectomy in Mature Cattle.

The prevention of pregnancy is desirable for female cattle destined for sale in the northern Australian rangelands for both economic and welfare reasons. Controlled access to bulls is often not feasible, nor are any non-surgical methods currently available. Many females are therefore surgically spayed. This study describes a technique for uterine tube resection (UTR), which leaves the ovaries intact and is performed using a vaginal approach, and compares the outcomes from 70 Brahman cows subjected to the procedure with 60 heifers spayed using the dropped ovary technique. The animals were monitored for 10 days following the surgery. There were no mortalities, and two animals were treated for illnesses after the UTRs and recovered. The animals subjected to both surgical procedures showed signs of pelvic discomfort and mild inflammation during recovery. The cows gained an average of 9.3 kg (SD 14.5 kg) of weight over the 10 days of the study compared to the spayed heifers, which lost 3.5 kg (SD 13.3 kg), with 19 and 63% of the animals in each of the groups losing weight, respectively. Uterine tube resection can be considered as a viable alternative to surgical spaying.

Navigating nutrition as a childhood cancer survivor: Understanding patient and family needs for nutrition interventions or education.

AIM: Nutrition challenges are common during childhood cancer treatment and can persist into survivorship, increasing the risk of non-communicable diseases. Evidence-based practice and implementation of nutrition interventions/education for childhood cancer survivors has been poorly investigated and may influence their future health. This study aimed to explore the nutrition interventions/education needs of childhood cancer survivors and the barriers and facilitators to delivering follow-up services in New Zealand. METHODS: Semi structured interviews were conducted with childhood cancer survivors and/or their families (n=22) and health professionals (n=9) from a specialist paediatric oncology centre in New Zealand. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed inductively using thematic analysis. A multi-level consensus coding methodology was used where each theme and associated subthemes were discussed with the study team for confirmation to ensure accurate coding and analysis. RESULTS: Three themes emerged from the analysis: (1) the current survivorship care pathway does not provide adequate interventions/education, (2) weight and dietary changes are common challenges and (3) requirements for interventions/education in survivorship are varied. Common nutrition-related concerns included fussy eating/limited dietary intake, poor diet quality, difficulties with tube weaning, and challenges with weight gain. Participants expressed a desire for education on healthy eating alongside information about cancer-related nutrition issues, such as learned food aversions. A preference for clear referral pathways and multifaceted interventions tailored to individual patient needs was identified. CONCLUSION: The trifecta of treatment side effects, negative feeding practices and poor messaging from health professionals creates a challenging environment to optimise nutrition. A stepped care model matching the intervention intensity with the childhood cancer survivors is required. Education for healthcare professionals will improve the delivery of timely interventions/education and monitoring practices.

Assessing the Social Cohesion of a Translocated Pride of White Lions Integrated with Wild Tawny Lions in South Africa, Using Social Network Analysis.

In South Africa, lions are protected in national parks and smaller fenced reserves. Translocating lions between fenced reserves, whilst necessary to maintain genetic diversity, is disruptive and can impact survivorship and pride cohesion. Critical to translocation success is pride cohesion. White lions are a natural colour variant occurring in the Greater Kruger Park Region, where anthropogenic threats eliminated this population until reintroduction in 2006. Through social network analysis (SNA), the sociality of a released pride of captive-origin white and wild tawny lions was compared to two captive-origin and wild prides of tawny lions. Social interactions and pride dynamics were recorded for each pride. For all prides, cubs and subadults were central to the play network, while adults received the most social interactions. White and wild tawny adult males initiated more social interactions than captive-origin tawny males, whilst a keystone adult female was identified in each pride. For the constructed pride, social interactions were more evenly distributed, suggesting a high level of connectedness and cohesion. This is the first study to demonstrate that captive-origin white and wild tawny lions can form a socially functional pride, suggesting that white lions would survive in the wild in the absence of anthropogenic threats.

Home Range and Movement Patterns of Reintroduced White Lions (Panthera leo melanochaita) in the Kruger to Canyons Biosphere Reserve, South Africa.

White lions are a colour variant of the African lion Panthera leo melanochaita and disappeared from the wild due to anthropogenic factors until their reintroduction to the Greater Kruger Park Region of South Africa in 2006. Natural home range behaviour is an index of reintroduction success. Therefore, the home range and movement of a pride of reintroduced white lions and a constructed pride consisting of reintroduced white lions and translocated wild tawny lionesses in small, fenced reserves was assessed. GPS data from collared adults were collected for the white lion pride between 2010-2011 and 2018-2020 for the constructed pride. Home ranges were estimated using kernel density estimation and minimum convex polygon, with minimum daily distance tested for differences between sex, season, and pride. Home ranges were small and average daily movements restricted for both prides (white lion pride: 5.41 km2 and 10.44 ± 4.82 km; constructed pride: 5.50 km2, 11.37 ± 4.72 km) due to the small reserve size of 7 km2. There was no difference between prides for annual and seasonal home range size, male and female home ranges, minimum daily distance travelled, or habitat selection. White lions from both prides established territories and displayed natural home ranging behaviour, suggesting that their reintroduction was successful, in the absence of anthropogenic threats.

Big Bang Nucleosynthesis Limits and Relic Gravitational-Wave Detection Prospects.

We revisit the big bang nucleosynthesis limits on primordial magnetic fields and/or turbulent motions accounting for the decaying nature of turbulent sources between the time of generation and big bang nucleosynthesis. This leads to larger estimates for the gravitational wave signal than previously expected. We address the detection prospects through space-based interferometers and pulsar timing arrays or astrometric missions for gravitational waves generated around the electroweak and quantum chromodynamics energy scale, respectively.

Effects of Arm-Crank Exercise on Fitness and Health in Adults With Chronic Spinal Cord Injury: A Systematic Review.

Individuals with spinal cord injury (SCI) may benefit less from exercise training due to consequences of their injury, leading to lower cardiorespiratory fitness and higher risks of developing cardiovascular diseases. Arm-crank exercise (ACE) is the most common form of volitional aerobic exercise used by people with SCI outside a hospital. However, evidence regarding the specific effects of ACE alone on fitness and health in adults with SCI is currently lacking. Hence, this review aimed to determine the effects of ACE on cardiorespiratory fitness, body composition, cardiovascular disease (CVD) risk factors, motor function, health-related quality of life (QoL), and adverse events in adults with chronic SCI. Inclusion criteria were: inactive adults (≥18 years) with chronic SCI (>12 months post injury); used ACE alone as an intervention; measured at least one of the following outcomes; cardiorespiratory fitness, body composition, cardiovascular disease risk factors, motor function, health-related QoL, and adverse events. Evidence was synthesized and appraised using GRADE. Eighteen studies with a combined total of 235 participants having an injury between C4 to L3 were included. There was a moderate certainty of the body of evidence on ACE improving cardiorespiratory fitness. Exercise prescriptions from the included studies were 30-40 min of light to vigorous-intensity exercise, 3-5 times per week for 2-16 weeks. GRADE confidence ratings were very low for ACE improving body composition, CVD risks factors, motor function, or health-related QoL. No evidence suggests ACE increases the risk of developing shoulder pain or other injuries. Overall, this review recommends adults with chronic SCI should engage in regular ACE to improve cardiorespiratory fitness. More high-quality, larger-scale studies are needed to increase the level of evidence of ACE in improving cardiorespiratory fitness and to determine the effects of ACE on other outcomes. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_reco rd.php?ID=CRD42021221952], identifier [CRD42021221952].

Exploring the barriers and facilitators to non-medical prescribing experienced by pharmacists and physiotherapists, using focus groups.

BACKGROUND: Non-medical prescribing (NMP) was introduced into the United Kingdom to enhance patient care and improve access to medicines. Early research indicated that not all non-medical prescribers utilised their qualification. A systematic review described 15 factors influencing NMP implementation. Findings from a recent linked Delphi study with independent physiotherapist and pharmacist prescribers achieved consensus for 1 barrier and 28 facilitators. However, item ranking differed for pharmacist and physiotherapist groups, suggesting facilitators and barriers to NMP differ depending on profession. The aim of this study was to further explore the lived experiences of NMP by pharmacists and physiotherapists. METHOD: Study design and analytical approach were guided by Interpretative Phenomenology Analysis principles. Focus groups (November and December 2020) used the 'Zoom®ï»¿' virtual platform with pharmacist and physiotherapist prescribers. Each focus group followed a topic guide, developed a priori based on the Delphi study results, and was audio recorded digitally. Transcripts underwent thematic analysis and data were visualised using a concept map and sunburst graph, and a table of illustrative quotes produced. Research trustworthiness was enhanced through critical discussion of the topic guide and study findings by the research group and by author reflexivity. The study is reported in line with COREQ guidelines. RESULTS: Participants comprised three physiotherapists and seven pharmacists. Five themes were identified. The most frequently mentioned theme was 'Staff', and the subtheme 'Clinical team', describing the working relationship between participants and team members. The other themes were 'Self', 'Governance', 'Practical aspects' and 'Patient care'. Important inter-dependencies were described between themes and subthemes, for example between 'Governance' and 'Quality and Safety'. Differences were highlighted between the professions, some relating to the way each profession practises (for example decision making), others to the way the prescribing role had been established (for example administration support). CONCLUSIONS: The key finding of collaborative working with the clinical team emphasises its impact on successful implementation of NMP. Themes may be inter-dependent, and inter-profession differences were identified. Specifically designed prescribing roles were beneficial for participants. For full NMP benefits to be realised all aspects of such roles must be fully scoped, before recruiting or training non-medical prescribers.

Australian Livestock Export Industry Workers' Attitudes toward Animal Welfare.

Understanding live export industry workers' attitudes and beliefs toward animal welfare can provide insight into their decision-making processes and likely behavior. Industry workers (n = 265) with various roles within the supply chain were surveyed from different global regions. Participants were divided into ten categories according to their industry roles and compared using ordinal regression. Respondents were highly likely to have a positive attitude toward animal welfare; the majority of workers enjoyed working with livestock (95.8%) and agreed that livestock should be treated with respect (97.7%). Workers demonstrated a strong understanding of animal welfare concepts, 168 respondents (63.4%) provided examples of ways they had improved animal welfare in their workplace, and 164 workers (61.9%) suggested ways that animal welfare could be improved further. Most workers (95.8%) agreed that animal welfare was satisfactory in their workplace. Five out of the 24 multiple-choice responses differed significantly by the participant's industry role, but no particular group displayed consistently divergent beliefs or attitudes. Given the community concern regarding animals in the livestock export supply chain, it is imperative to understand the attitudes of industry personnel who are responsible for the daily management of the animals. This knowledge assists in the development of animal welfare policy and can inform strategies to manage public perception.

Rare case of multisystem sarcoidosis.

Sarcoidosis is a multisystem disorder of unknown cause, characterised pathologically by granulomas and primarily affecting the lung and lymphatic system of the body. It has been termed the 'great pretender' due to its ability to mimic other diseases. In this article we describe a case of sarcoidosis with simultaneous rare manifestations of extrathoracic disease (thyroid, osseous and renal). It highlights the enigmatic nature of sarcoidosis and the diagnostic challenge it can pose to clinicians. A multidisciplinary approach to both diagnosis and management between endocrinology, nephrology, neurosurgical, rheumatological and respiratory teams was paramount for effective clinical improvement.

A Delphi study to explore and gain consensus regarding the most important barriers and facilitators affecting physiotherapist and pharmacist non-medical prescribing.

Non-medical prescribing was introduced into the United Kingdom to improve patient care, but early research indicated a third of Allied Health Professionals may not use their prescribing qualification. A previous literature review, highlighting factors influencing prescribing, identified only papers with nursing and pharmacy participants. This investigation explored consensus on factors affecting physiotherapist and pharmacist non-medical prescribers. A three round Delphi study was conducted with pharmacist and physiotherapist prescribers. Round One comprised information gathering on facilitators and barriers to prescribing participants had experienced, and underwent content analysis. This was followed by two sequential consensus seeking rounds with participants asked to rate the importance of statements to themselves. Consensus criteria were determined a priori, including median, interquartile range, percentage agreement and Kendall's Coefficient of Concordance (W). Statements reaching consensus were ranked for importance in Round Three and analysed to produce top ten ranks for all participants and for each professional group. Participants, recruited October 2018, comprised 24 pharmacists and 18 physiotherapists. In Round One, content analysis of 172 statements regarding prescribing influences revealed 24 themes. 127 statements were included in Round Two for importance rating (barriers = 68, facilitators = 59). After Round Two, 29 statements reached consensus (barriers = 1, facilitators = 28), with no further statements reaching consensus following Round Three. The highest ranked statement in Round Three overall was: "Being able to prescribe to patients is more effective and really useful working [in my area]". Medical support and improved patient care factors appeared the most important. Differences were noted between physiotherapist and pharmacist prescribers regarding the top ten ranked statements, for example team working which pharmacists ranked higher than physiotherapists. Differences may be explained by the variety of practice areas and relative newness of physiotherapy prescribing. Barriers appear to be post or person specific, whereas facilitators appear universal.

Exploring feedback from research nurses in relation to the design and conduct of a randomised controlled trial of wound care treatments: A sequential, dependent, mixed-methods study.

BACKGROUND: Research nurse involvement in trials is crucial to successful conduct, however their feedback on trial design and conduct is not necessarily always collected and shared. This study was designed to explore research nurse feedback in relation to study and protocol design and implementation in the National Institute for Health Research Programme Grants for Applied Research funded Surgical Wounds Healing by Secondary Intention pilot and feasibility trial (SWHSI). The primary aim of this study was to inform the design and conduct of a proposed future, larger study in this area. Given the evidence gap, it was deemed prudent to share these findings for the benefit of others. METHODS: A sequential, dependent mixed methods study, comprising a Likert scale questionnaire and semi-structured interviews, explored the experiences, in relation to study design and conduct, of research nurses involved in the trial. Of the 10 research nurses involved in the trial, eight nurses completed a questionnaire and were interviewed. Questionnaire data was analysed using descriptive statistics and interview data using thematic analysis. RESULTS: A range of questionnaire responses were provided, however at least 50% (n = 4) of respondents indicated that they were happy with both the study design and conduct. Interview data identified key themes to consider when involving research nurses in the design, delivery and conduct of RCTs; removing barriers to recruitment, time management, engagement strategies and resource provision. CONCLUSION: Engagement of research nurses is important to enable effective trial conduct. Research teams should therefore consider how best to obtain and include input from all members of the research team from the outset. Furthermore, the sharing of feedback on research design and conduct, from the perspective of research nurses delivering trial recruitment and retention, remains crucial to effective and efficient trial conduct. TRIAL REGISTRATION: Clinical Trial Registry: ISRCTN12761776. Date of registration: 10th December 2015.

Review of Livestock Welfare Indicators Relevant for the Australian Live Export Industry.

Animal welfare is an important issue for the live export industry (LEI), in terms of economic returns, community attitudes and international socio-political relations. Mortality has traditionally been the main welfare measure recorded within the LEI; however, high mortality incidents are usually acted upon after adverse events occur, reducing the scope for proactive welfare enhancement. We reviewed 71 potential animal welfare measures, identifying those measures that would be appropriate for use throughout the LEI for feeder and slaughter livestock species, and categorised these as animal-, environment- and resource-based. We divided the live export supply chain into three sectors: (1) Australian facilities, (2) vessel and (3) destination country facilities. After reviewing the relevant regulations for each sector of the industry, we identified 38 (sector 1), 35 (sector 2) and 26 (sector 3) measures already being collected under current practice. These could be used to form a 'welfare information dashboard': a LEI-specific online interface for collecting data that could contribute towards standardised industry reporting. We identified another 20, 25 and 28 measures that are relevant to each LEI sector (sectors 1, 2, 3, respectively), and that could be developed and integrated into a benchmarking system in the future.

Developing an Animal Welfare Assessment Protocol for Livestock Transported by Sea.

Australian livestock industries face increased scrutiny from animal welfare groups and society, and the long-distance transport of livestock by sea has recently gained particular attention. Other than non-compliance with broad regulatory standards and voyage mortality rates, there is minimal information to ascertain the welfare of exported livestock. There is currently no standardised, validated animal welfare assessment protocol for livestock on-farm prior to live export or when undergoing transport. This study describes a novel assessment protocol suitable for use on live feeder and slaughter animals exported by sea from Australia. Health and welfare indicators for use in the livestock export supply chain were identified by reviewing three internationally recognised animal welfare assessment protocols for livestock; Welfare Quality®, AWIN and AssureWel, as well as consulting with industry compliance standards and guidelines. This paper proposes a welfare protocol designed to assess sheep and beef cattle exported by sea from Australia, and incorporates environmental-, resource-, management- and animal-based measures. In collaboration with industry, this welfare protocol can be tested on commercial livestock consignments, and be used for ongoing management, for increased transparency and to provide feedback to operators for continuous improvement.

Sertraline-induced hypersensitivity pneumonitis.

Hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis, is a granulomatous, non-IgE-mediated hypersensitivity reaction of the alveoli and distal bronchioles presenting as an acute, subacute or chronic condition. It is most commonly associated with exposure to extrinsic allergens (eg, avian dust, mould and tobacco) and medications including antiarrhythmics (eg, amiodarone), cytotoxics (eg, methotrexate) and antiepileptics (eg, carbamazepine). Individuals diagnosed with this condition can present with severe hypoxia and respiratory failure. The fundamental principle of management is to remove the causative allergen. Evidence implicating selective serotonin reuptake inhibitors as a causative agent is limited, and this case report describes a rare clinical presentation of HP associated with sertraline, how it was diagnosed and subsequently treated. It is anticipated that raising awareness of this interaction will assist multidisciplinary teams, managing patients diagnosed with HP, to be more cognisant of sertraline as being an aetiological factor for this condition.